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January 23/30, 2013

Tension Between Quality Measurement, Public Quality Reporting, and Pay for Performance

Author Affiliations

Author Affiliations: Center for Cardiovascular Innovation, Department of Medicine, Feinberg School of Medicine (Drs Farmer and Bonow), Kellogg School of Management (Dr Farmer and Mr Black), and School of Law (Mr Black), Northwestern University, Chicago, Illinois.

JAMA. 2013;309(4):349-350. doi:10.1001/jama.2012.191276

Accurate measures of outcomes are necessary to improve the quality of US health care and address geographic, socioeconomic, and racial/ethnic variations in care quality. However, 2 major initiatives that seek to improve quality—public reporting of outcomes and pay for performance (P4P)—have the potential to reduce the reliability of the administrative data on which they are often based and generate spurious estimates of performance.

Outcome data are often derived from administrative (billing) data rather than clinical patient records because billing data provide readily available information on large numbers of patients. Furthermore, every physician and hospital must use the same codes, which are derived from the International Classification of Diseases Clinical Modification and Current Procedural Terminology Coding. Other specialized data sources exist, such as disease-specific registries, but these are limited in scope and often enforce confidentiality of clinicians and hospitals.